> Uganda Ministry of Health Scandals, UNICEF Withdraws $$

UNICEF is the latest organization to withdraw funding from Uganda, citing a lack of accountability. Corruption and management troubles within Uganda’s weak Health Ministry is beginning to affect service delivery.

Ministers’ Clashes Cripple Health

CHRIS OBORE (KAMPALA)

PERSONAL animosity between the ministers of Health has spread to infect other officials in the department with signs that the delivery of health services is beginning to suffer.

Some donors, for example, have had to withdraw money already given to the ministry because they are dissatisfied with the management of projects they fund.

In January, Unicef withdrew $14 million (Shs23.8 billion) meant for the fight against HIV/Aids and malaria through reaching out directly to people in the villages.

“They asked it to be withdrawn,” said Dr Sam Zaramba, the director-general of Health Services. “We had a few programmes which had not accounted in time. It made Unicef not to send more money, and what they had sent they also took back.”

He said Unicef policy is that they don’t release more money unless the accountability for previous funds is made meaning that the projects for which Unicef had sent money, stall.

By the time Dr Zaramba talked to Sunday Monitor, he said he had no accurate figures of the monies Unicef gives to the ministry “but their money is for all projects including water. Unicef supports the ministry activities.”

Dr Zaramba added that “sometimes the problem was at ministry headquarters. Many times it is the problem with our officers. Some of the officers are a bit unruly; they don’t adhere to financial regulations as set out by government”.

He also, however, blamed health officials at the district level for delaying to account for project money.

Other key international agencies like the World Health Organisation have also reportedly withdrawn some funding, which amount we are yet to establish.

Although Dr Zaramba attributes the withdrawal of money to accounting problems, it is the case that ministerial ego clashes that have since had bureaucrats take sides are hampering this critical ministry’s work.

Things are so bad that top officials trooped to Murchison Falls National Park recently to try to patch up their differences.

Sunday Monitor reported in November last year that Health Minister Stephen Mallinga and one of his junior colleagues, Dr Emmanuel Otaala, have bad blood running between them.

The fight started when Dr Mallinga objected to Dr Otaala, who is in charge of primary health care, owning two ministry vehicles because it was against government regulations.
Dr Otaala did not take kindly to that; and also accused Dr Mallinga of denying him foreign trips.

Subsequently, the two men traded hot words during a top departmental meeting, forcing their colleague Richard Nduhuura, responsible for general duties, to leave the room in disgust.

Dr Mallinga consequently appealed for Prime Minister Apolo Nsibambi’s intervention. Sunday Monitor has learnt that this ill feeling has now spread across the ministry’s hierarchy with some technocrats siding with Dr Mallinga and others with Dr Otaala.

Sources who asked for anonymity in return for speaking candidly to this newspaper said that the hostility at the ministry is leading to failures in supervision hence poor absorption of donor money and lousy implementation of Health projects.

Money matters
Matters reached a high point after Dr Mallinga and Permanent Secretary Mary Nannono stopped money going directly to projects but through the ministry’s budgetary system.

This decision, sources said, displeased several ministry bureaucrats because they earned extra pay by leading donor-funded projects.

“The Ministry of Health has been very corrupt; Mallinga and Nannono are just trying to improve it,” a source said.

In an attempt to fail the minister and PS’s directive, therefore, some technocrats sabotaged programmes by refusing to implement them.

Others opted for blackmail by manipulating the differences between Dr Mallinga and Dr Otaala. As a result, some officials now belong either to the Mallinga camp or the Otaala camp.

“Yes, I instructed that all money to the ministry must come through the budget,” said Dr Mallinga. “Resisting it does not help because I want things done in order. Some donor money is not being used but that is unfortunate. We need money to improve our services.”

Dr Zaramba said indeed a number of officials at the ministry, including himself, received additional pay from project funds.
Asked how much he was getting and from which projects, Dr Zaramba replied, “That is my secret.”

He said that “sometimes instead of having project implementation units, we encourage funders to give some allowance to some people who do extra tasks”. PS Nanono said the Ministry of Public Service originated the directive to stop such payments.

“They used to call it top-up allowances but that payment stopped as soon as I came in last year,” she said.

Asked whether the conflict between ministers was impeding service delivery, Dr Zaramba said: “Obviously, the disagreement within the political leadership ends up with disharmony in the ministry as you have read in the newspapers before.”

He said that health workers are greatly underpaid, therefore, “those who didn’t get top-up allowances were disgruntled. Even those who were getting are now disgruntled. But we have to go by the provisions of government”.

More trouble
Promotions of key officers have not been spared by the ministerial fallout. Dr Zaramba is accused of sabotaging Mr Samuel Okware’s promotion to the position of director of Health Services in charge of clinical services, a post Dr Zaramba held before moving up.

The pro-Okware group, which is said to be on Dr Mallinga’s side, says its man has competently handled nearly every epidemic in the country starting with HIV/Aids yet when opportunity for promotion arose, he was passed over.

The job went to Dr Kenya Mugisha, who was junior to Dr Okware.
But Dr Zaramba said, “I excused myself from the panel of interviewers because Dr Mugisha is my friend and Dr Okware was my classmate at Makerere College School.”

“Although [Dr Mugisha] was junior to Dr Okware, he is also a senior consultant paediatrician.” Now the pro-Okware and pro-Mugisha groups are reportedly reluctant to undertake some programmes if they are not supervised by their preferred ministerial boss. For instance, the immunisation campaign has stalled.

The atmosphere at the ministry deteriorated so much so that senior officials held a two-and-a-half-day retreat last month at Paraa Safari Lodge in Murchison Falls National Park to review their performance.

“We are very concerned because it is not good that programmes are not implemented,” said Dr Zaramba. “We reviewed the way we operate and resolved to improve the way we are working with each other. Team-building is our big challenge we are addressing now. We have resolved to deliver services expected of us through the Paraa spirit of togetherness.”